Term: Intensive Care Unit - ICU


Description

The intensive care unit (ICU) monitors patients in critical conditions who need constant care. Though patients have a broad range of medical conditions, typical conditions are organ or respiratory system failures or patients affected by mulitple injuries. Since patients in the Intensive Care Unit have a wide range of conditions, ICU staff must have a lot of clinical experience to effectively treat patients.

Equipment

The ICU must be capable of treating a broad array of medical emergencies. They are typically equipped with the following types of equipment:

  • Defibrillators, EKGs, and other equipment for cardiac issues.
  • Specialized beds
  • OTC and prescription grade narcotics for pain management
  • A broad range of antibiotics, sedatives, paralytics, blood thinners, and other specialized medications
  • Anesthetic machines for general anesthesia and medicine for local anesthesia
  • Wheelchairs, crutches, and other mobility devices
  • Blood pressure and pulse machines

Benefits

1. Patients receive exclusive care with a ratio of one or two nurses per bed.
2. Continuous monitoring of patients' health (heart and blood pressure monitors).
3. Advanced medical tools keep critical patients stable and alive.

Drawbacks

1. ICUs need constant power to keep health monitors running and ventilators working. Hospitals need generators hooked up to the ICU in case of a power outage.
2. Very expensive to operate - Advanced tools are needed to keep patients alive. Many tools are disposed of to prevent cross contamination among patients and hospital staff.
3. High demand for staff - 1-2 Nurses per bed, as well as head nurses, lab assistants, consultants, etc.
Patients must be local to hospitals with ICUs.
4. Changeovers - Physicians may be tempted to overlook patients who are listed at the end of a roster during shift changeovers. This can create medical errors.

Solutions to Drawbacks

eICU - The concept of the e-ICU eliminates several of the drawbacks of a physical Intensive Care Unit, particularly the high costs of an ICU and the demand for a 1:1 ratio of nurses to patients.
Changeovers - Physicians can begin prioritizing patients based on actual status, rather than room numbers or by the order of their names.

Specialty ICUs

Some ICUs are designed for specialized purposes. Here are some examples:

- Medical/Surgical/Respiratory ICUs often serve as the primary ICU and they cover all of the conditions that are categorized under their name.
- Cardiac ICUs are able to handle a wide array of issues involving the heart. Heart attacks (myocardial infarction), congestive heart failure, and a myriad of other conditions can be stabilized.
- Neurological ICUs handle issues with the brain and spinal cord.
- Trauma/Burn ICUs handle wounds that are due to arson or sudden trauma. Gunshot wounds, stabbings, and automobile-related injuries are often referred to these ICUs. Some hospitals do not maintain this type of specialty ICU and the duties are delegated elsewhere.

Graphics
external image icu04.jpg

Qualifying for the Intensive Care Unit (ICU)

Persons who are critically ill may be admitted to the ICU from the emergency room, a surgical ward, or from any other hospital department. ICUs are arranged around a central station so that patients can be seen either through the room windows or from a nursing station a few steps away. Patients are given 24-hour assessments by the intensivist. Preparatory orders for the ICU generally vary from patient to patient since treatment is individualized. The initial workup should be coordinated by the attending ICU staff (intensivist and ICU nurse specialist), pharmacists (for medications and IV fluid therapy), and respiratory therapists for stabilization, improvement, or continuation of cardiopulmonary care. Well-coordinated care includes prompt consultation with other specialists soon after the patient is admitted to the ICU. The patient is connected to monitors that record his or her vital signs(pulse, blood pressure, and breathing rate). Orders for medications, laboratory tests, or other procedures are instituted upon arrival.

In general, there are eight categories of diseases and disorders that are regarded as medical justification for admission to an ICU. These categories include disorders of the cardiac, nervous, pulmonary, and endocrine (hormonal) systems, together with postsurgical crises and medication monitoring for drug ingestion or overdose. Cardiac problems can include heart attacks (myocardial infarction), shock, cardiac arrhythmias (abnormal heart rhythm), heart failure (congestive heart failure or CHF), high blood pressure, and unstable angina (chest pain). Lung disorders can include acute respiratory failure, pulmonary emboli (blood clots in the lungs), hemoptysis (coughing up blood), and respiratory failure. Neurological disorders may include acute stroke (blood clot in the brain), coma, bleeding in the brain (intracranial hemorrhage), such infections as meningitis, and traumatic brain injury (TBI). Medication monitoring is essential, including careful attention to the possibility of seizures and other drug side effects.

When patients are transferred to the ICU from another hospital department, treatment orders and planning must be reviewed and new treatment plans written for the patient's current status. For example, a chronically ill inpatient may grow markedly worse within a few hours and may be transferred to the ICU, where the staff must reevaluate orders for his or her care.

ICU Statistics

A large and comprehensive study conducted in 1992 by the Society of Critical Care Medicine in collaboration with the American Hospital Association found that approximately 8% of all licensed hospital beds in the United States were designated for intensive care. The average size of an adult or pediatric ICU averaged 10–12 beds per unit. Small hospitals with fewer than 100 beds usually had one ICU, whereas larger hospitals with more than 300 beds usually had several ICUs designated for medical, surgical, and coronary patients. Smaller hospitals do not usually have a full-time board-certified specialist in critical care medicine, whereas larger medical centers generally employ certified intensivists—60% of hospitals with more than 500 beds had full-time specialist directors at the time the survey was conducted.

With regard to the nursing staff in ICUs, the proportion of nurses with specialized and advanced training in critical care medicine is higher in larger medical centers—about 16% in hospitals with 100 beds or fewer, but 21% in hospitals with more than 500 beds.

Most pediatric ICUs have four to six beds per unit. The mortality rate in pediatric ICUs tends to increase in proportion to size, with larger units reporting more deaths (approximately 8% in the larger units). Eighty percent of pediatric ICUs have full-time medical directors.

References

Intensive Care: http://www.nlm.nih.gov/medlineplus/criticalcare.html
Organization of ICU: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1115845/
Journal of Health: http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijh/vol3n2/icu.xml
Occupational Safety & Health Association on the ICU: http://www.osha.gov/SLTC/etools/hospital/icu/icu.html
Changeovers: http://capsules.kaiserhealthnews.org/index.php/2012/11/hospital-shift-changes-a-dangerous-time-for-patients/
Specialty ICUs: http://www.icu-usa.com/neurologic.html
​ICU Statistics: http://www.surgeryencyclopedia.com/Fi-La/Intensive-Care-Unit.html#b
Qualifying for the Intensive Care Unit: http://www.surgeryencyclopedia.com/Fi-La/Intensive-Care-Unit.html#b